Urinary Incontinence

Urinary incontinence, often called loss of bladder control, is the unwanted loss or leak of urine. It is a symptom not a disease caused by a variety of conditions, common in millions of women which can be a source of great embarrassment. One out of every four women has urinary incontinence after the age of 30 years, and eight out of ten who are affected mistakenly believe that incontinence is a normal part of aging. They believe that it is a temporary problem which would go away on its own or they would have to just live with it.

How does urination occur?

The act of urination or micturition involves a very complex synergy between higher centers, spinal reflexes and the bladder whose prime aim is to store and void urine whenever the time is right. This is a reflex that is initiated when the volume of urine reaches about 300ml, when stretch receptors in the bladder wall are stimulated and transit impulses to the brain, leading to a conscious desire to micturate.

How does urinary incontinence occur?

Urinary incontinence is involuntary ( not in your control) leakage of urine and can happen as a disruption of any of the complex pathways or simply due to failure of bladder function.

The main types of incontinence are:

1. Urge incontinence: Leakage of urination follows a strong desire to pass urine and a female cannot control it till she reaches the washroom to evacuate.

2. Stress incontinence: The urinary leak takes place during certain activities which increase abdominal pressure like coughing, sneezing, laughing etc.This is more commonly seen in elderly females and results due to a weakness of the control mechanisms responsible for the continence. It may result from hypermobility of urethra and functional insufficiency of the urethral sphincter

The Indian style of dressing may allow the incontinent female to hide a great degree of leakage and the lack of social interaction may also prevent the women from seeking help. But change in dressing style and increased awareness about this issue has made women seek help from gynecologists. 

It is very important to determine the type of incontinence as the treatment of each type varies and the patient may not benefit from improperly directed therapy. So at first sitting, our cosmetic gynecologist.will completely evaluate you to determine the type of incontinence, to understand the level of defect and then may do some investigations to duly confirm them like:
➡️ Routine blood tests- Blood sugar
➡️ Routine urinalysis
➡️ USG to detect post void residual urine

Modalities for Treatment of UI

➡️ Conservative Therapy
➡️ Surgical Treatment
➡️ Laser for Stress Urinary Incontinence (FEMILIFT)

1. Conservative Therapy- Kegel Exercise
The most probable cause of SUI is weak pelvic floor due to child birth, menopause,asthma, smoking, excess weight or herditary. Kegel exercise done with compliance can work very well if the patient seeks help in early stages.It is a rehabilitation technique used to tighten and tone the pelvic floor muscles that have become weak over time, hence called Pelvic Floor Muscle Training (PFMT). These exercises empower the external urinary sphincter to prevent stress incontinence and build up the pelvic floor muscles to avert impending pelvic prolapse.Kegel exercise are even effective to prevent urge incontinence.
But compliance is a must with kegel exercise. The young patients can easily understand the group of pelvic floor muscles which need to be trained but older women may require adjunct treatment like biofeedback or electrical stimulation.

2. Surgical Treatment- Mid Urethral Slings- TVT/TOT

Many extensive surgeries are available for Urinary incontinence but nowadays Mid urethral Sling surgery is preferred over other surgeries because of following reasons:

➡️ Minimally invasive
➡️ Permit reconstruction without destruction
➡️ Offers long term success
➡️ Can be combined with surgery for uterine prolapse
➡️ Can be used for both causes of UI like urethral hypermobility and intrinsic sphincter deficiency.

Tension Free Vaginal Tape (TVT) –

With TVT,polypropylene mesh is placed tension free under the mid urethra, via vaginal approach exiting abdominally through the retropubic space. Restoration and Reinforcement of supporting structures around the urethra is achieved by facilitating the growth of fibroblast around the sling. It has the highest success rate comparable with open extensive surgery performed for UI.

Risk of TVT:
These were thought to be related to blind entry of needle into the retropubic space
➡️ Vascular injury
➡️ Bowel injury
➡️ Bladder injury

TransObturator Tape (TOT):
The surgical principle of TOT is based on the Hammock Theory . It is said that ligaments and muscles below urethra form a hammock like structure and in the normal continent female, increase in urethral closure pressure during stress, occurs because the urethra is compressed against the hammock.
It was found that Urinary incontinence was due to tension arising within a suburethral hammock formed by pelvic floor muscles and so no more can support urethra.

New innovative minimally invasive mid urethral sling( Polypropylene mesh) is Trans Obturator Tape which is placed by placing the sling from inside out through obturator holes in the female pelvis, in an attempt to minimize the inadvertent injury to urinary tract. It has similar results like TVT but the complications in terms of vascular, bowel or nerve injury are minimal.

TOT has better results than Laparoscopic Surgery for SUI and very less complications.

3. Laser Treatment for Stress Urinary Incontinence (FEMILIFT)

Femilift is a very successful solution which utilizes highly advanced CO2 laser technology to treat a wide range of feminine issues including SUI.Femilift is US FDA approved for the treatment of SUI.
Femilift is a small handheld device that emits laser heat energy.The device is gently inserted into the vaginal canal, where laser beam is emitted and energy is delivered to the vaginal walls and under urethra to stimulate muscle contraction. As muscles contract and tighten, they produce excess collagen which increases the thickness of the hammock below the urethra and increases lubrication too. WIth single treatment, your muscles will feel tighter and stronger and a lot of improvement could be seen in your symptoms.
While some of the patients may require multiple sittings to completely get rid of SUI.

Benefits of Femilift

➡️ Minimally invasive, no damage to your tissues
➡️ Minimal chance of vascular or nerve injury.
➡️ Simultaneously increase collagen formation in vaginal walls so treat vaginal laxity too.

Dr.Shraddha Goel, at PCOSmetic Gyne Clinic routinely performs mid sling procedure TOT and Femilift in Jaipur for the cure of SUI after complete evaluation of patients and help you to decide which procedure will give you the maximum results.